Repetitive Strain Injury (RSI) is a general term used to describe pain in muscles and tendons from a repetitive action, commonly in the forearms and hands. In a nutshell, repetitive strain injury is a diagnosis by exclusion. The problem is that even now there are very few objective diagnostic measures to diagnose RSI – it is usually given as a defining term for a soft tissue injury that occurs because of a repetitive action. Not enough research has been done to determine an RSI diagnosis from X-rays or MRI scans; instead the practitioner has to enquire into the onset of the injury and the character of the patient’s pain.
If a certain pattern emerges, it is then diagnosed as an RSI. Presenting usually when a certain movement, done over long periods of time becomes uncomfortable, then really quite painful to do. The only relieving factor patients can find is to stop doing that particular movement.
When a soft tissue structure is used in a certain way for longer periods of time, the body’s recovery mechanisms often don’t have the capacity to catch up and repair the part. If this happens over longer periods of time, the body starts using pain as a warning signal for us to stop. This means that pain in chronic RSI is not directly linked to tissue damage – and more to our brain’s fear of potential damage.
Although many may think RSI only affects people in musical professions, labour intensive trades or office based work, I have encountered it most often as a sports related injury. This may well as a result of years of tension, built up in a patient, suddenly pushed over the edge by extra stress put on the part that is already uneasy. For me, injuries like tennis or golfers elbow, sub acromial impingement are injuries that are usually accumulated over time through a movement that the body is not ready to do yet, done over and over again or simply incorrectly many times over.
The best first aid for RSI is actually quite simple – stop, ice the area and give it a rest. Ice is an incredible anti inflammatory agent and analgesic. It will reduce inflammation in the area, make it easier and temporarily make it hurt a lot less. Rest simply gives the body time to catch up on necessary repair work. Acute RSI can very easily turn into a tear, in which the affected structure simply gives in. This takes even longer to recover from so is better avoided. If the injury reoccurs, it is well worth considering getting help from personal trainers or coaches, be it for golf or tennis. They can analyse the movement causing the trouble and give tips of how to change the movement to avoid recurrence.
As osteopaths we often look into muscle chains, work into muscles around and we may well hit a few areas that are not painful. A muscle doesn’t need to be painful to need treatment. If we detect tightness in a certain muscle, we will work into it to reduce overall tension. I see RSI of a failure of the weakest link in a chain; the movement is done with the whole chain of muscles in legs, torso and arms. If there are flaws in the movement, the weakest link will show.
In clinic it is often difficult to reproduce the exact aggravating movement because of lack of space and time. These injuries are often accelerated by fatigue and depending of the fitness level it may be difficult to exhaust you sufficiently for the faulty movement pattern to show. Although there are often parallels in injury mechanisms, it is still worth having someone else observe you next time a certain exercise is done.